Healthcare Provider Details

I. General information

NPI: 1821913633
Provider Name (Legal Business Name): BLOOM NEUROTHERAPY AND COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6797 N HIGH ST STE 223
WORTHINGTON OH
43085-2533
US

IV. Provider business mailing address

6797 N HIGH ST STE 223
WORTHINGTON OH
43085-2533
US

V. Phone/Fax

Practice location:
  • Phone: 614-505-9041
  • Fax: 614-412-5572
Mailing address:
  • Phone: 614-505-9041
  • Fax: 614-412-5572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MARIE GOTTFRIED
Title or Position: OWNER/THERAPIST
Credential: LPCC-S
Phone: 614-505-9041